Late-Onset Paraplegia in Old Healed Spinal Tuberculosis Due to Traumatic Fracture of Fusion Mass – A Rare Case Report

Abstract

The natural healing of spinal tuberculosis occurs by spontaneous fusion of vertebral bodies with or without kyphotic deformity. Late-onset paraplegia secondary to the fracture of fusion mass in tuberculosis is one of the rare conditions which have not been extensively reported. A 56-year-old male patient sustained road traffic accident was diagnosed with a fracture of fusion mass in already healed tuberculosis. He was presented with weakness in both the lower limbs with ASIA-C grading of spinal cord injury. He was treated with posterior instrumented stabilization and decompression. The patient recovered well postoperatively and had regained his complete power of both lower limbs. Late-onset paraplegia in old healed spinal tuberculosis is a well-known entity that may be caused due to transaction of the cord by a bony ridge or when the formed granulation or fibrous tissue constricts the cord. Fusion mass fractures are not very uncommon in conditions such as ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. Traumatic fractures tend to occur at the adjacent vertebral bodies to the fused ones as the biomechanical stress at the junctional site is far higher than at the center of the fused mass. In healed spinal tuberculosis, resultant deformity would be kyphosis. The angle of kyphosis is directly proportional to the resulting neurological deficit. Fractures of fused mass in healed tuberculosis are similar to the fractures in other ossifying bone lesions. The purpose of this article is to document the rare possibility of late-onset paraplegia in uninstrumented old healed spinal tuberculosis with kyphotic deformity, due to the fracture of fusion mass as seen in ankylosing spondylitis.